Provider First Line Business Practice Location Address:
18818 HWY 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-0009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-995-8813
Provider Business Practice Location Address Fax Number:
760-995-8929
Provider Enumeration Date:
05/09/2007